E2. Student Review Level I FW:Analysis of Occ Perf

Self Evaluation of professional and learning behaviors during Level I Fieldwork-Analysis of Human Occupational Performance.

Student Name * First Last
Date * / MM / DD YYYY
Facility Name *
Primary Fieldwork Setting *
If Other, please describe the primary fieldwork setting *
List the assessments you used to meet the course objectives at this facility. *
Please rate the experience on a scale from 1-5 on the following:

5= Far Exceeds Standards:
My performance was highly skilled and self-initiated. Performance was the best that could be expected from any student level I or level II.

4= Exceeds Standards:
I frequently completed tasks and activities that exceed requirements/objectives.

3= Meets Standards:
Completed required tasks and activities to meet objectives. This rating reflects good performance for a student at this level. (This rating should be used most frequently.)

2= Below Standards:
My performance is progressing, but need improvement to meet objectives. I did not demonstrate adequate response to feedback. My performance was occasionally unacceptable.

1= Unsatisfactory:
My performance was poor or frequently unacceptable in most required activities and tasks. I did not met the objectives of this experience.

0= I was not given the opportunity to demonstrate.
I exhibited a professional image. 5 4 3 2 1 0
I demonstrated a respect for time (arriving on time, began/ended treatment on time, used time wisely, etc.) 5 4 3 2 1 0
My behaviors indicated an interest in learning (e.g. asked for help/feedback appropriately, asked appropriate questions, sought extra learning opportunities, etc.) 5 4 3 2 1 0
I demonstrated carryover, adjusting my performance based on feedback. 5 4 3 2 1 0
I attended all scheduled clinical days. Yes No
I interacted with clients and staff appropriately and professionally. 5 4 3 2 1 0
I asked appropriate questions that showed incorporation of prior knowledge and/or that demonstrated a higher level of assimilation of learned materials. 5 4 3 2 1 0
I adhered to all safety regulations in the practice setting. 5 4 3 2 1 0
I adhered to ethics and confidentiality (HIPAA) during interactions with clients, families, and other professionals. 5 4 3 2 1 0
Under supervision, I selected and applied assessment tools considering the clients' needs, cultural factors, and contextual factors. 5 4 3 2 1 0
Under supervision, I evaluated clients' occupational performance in ADL's and IADL's, using standardized and/or non-standardized screening and assessment tools to determine the need for occupational therapy intervention. 5 4 3 2 1 0
I developed an intervention plan based upon evaluation findings, appropriate theoretical perspectives, and client needs. 5 4 3 2 1 0
I demonstrated therapeutic use of self, including my personality, insights, perceptions, and judgement, as part of the therapeutic process (particularly in assessments) in both individual and group interaction. 5 4 3 2 1 0
I demonstrated clinical reasoning to analyze evaluation, synthesize, and diagnose problems related to occupational performance and participation. 5 4 3 2 1 0
Under supervision, I interpreted and reported assessment results based on the psychometric properties of tests, considering factors that might bias assessment results and in relation to accepted terminology of the profession. 5 4 3 2 1 0
I applied, analyzed and evaluated the interaction of occupation and activity, including areas of occupation, performance skills, performance patterns, activity demands, context(s) and environments, and client factors. 5 4 3 2 1 0
I demonstrated the ability to analyze and evaluate the effects of heritable diseases, genetic conditions, disability, trauma, and injury to the physical and mental health and occupational performance of the individual. 5 4 3 2 1 0
What was the most important thing you learned from this fieldwork experience? *
What was the second most important thing you learned from this fieldwork experience? *
What did you like least about this experience? *
What suggestions do you have to improve this level I fieldwork experience? *
If another student is assigned to the same facility next semester for Level I FW Analysis of Occupational Performance, what would be your advice to them? *
I acknowledge that the person completing this evaluation is the student listed above. Furthermore, I have reviewed this evaluation with the fieldwork educator (site).
Yes No
Student email address: *
*NOTE: You may print this evaluation after clicking on "CONTINUE" and before choosing "SUBMIT". *You have not submitted until you click "SUBMIT".

E2. Student Review Level I FW:Analysis of Occ Perf

E2. Student Review Level I FW:Analysis of Occ Perf

*NOTE: You may print this evaluation after clicking on "CONTINUE" and before choosing "SUBMIT". *You have not submitted until you click "SUBMIT".

NOTE: You may print this evaluation after clicking on "CONTINUE" and before choosing "SUBMIT". You have not submitted until you click "SUBMIT".